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Columbia Gniversitp 
inthe Citp of Hew Pork 


College of Physicians and Surgeons 
Library 


q _ Digitized by the Internet Archive 
in 2010 with funding from 


Open Knowledge Commons ~ 


STANDARDS 
OF NUTRITION 
AND GROWTH 


L. EMMETT HOLT, M.D. 


CHILD HEALTH ORGANIZATION 
289 FOURTH AVENUE, NEW YORK 


CHILD HEALTH ORGANIZATION 


ACTING WITH THE 
NATIONAL CHILD LABOR COMMITTEE, Inc. 


HEALTH IN EDUCATION 


EDUCATION IN HEALTH 


EXECUTIVE COMMITTEE 


Dr. L. EMMETT HOLT, Chairman 
V. EVERIT MACY, Treasurer 

Dr. SAMUEL McC. HAMILL 
Mrs. JOHN COLLIER 

Dr. GODFREY R. PISEK 


Dr. VICTOR G. HEISER 

Mrs, FREDERICK PETERSON 

Dr. BERNARD SACHS 

Mrs. FRANK A. VANDERLIP 4 
Dr. THOMAS D. WOOD 


STAFF 
OWEN R. LOVEJOY, Secretary 
EDWARD N. CLOPPER, Assistant Secretary 
SALLY LUCAS JEAN, Director of Field Work 


GENERAL COMMITTEE 


Dr. L. EMMETT HOLT, Chairman 


LEO ARNSTEIN, New York 

Dr. S. JOSEPHINE BAKER, New York 
Mrs. CHARLES A. BEARD, New York 
Dr. HERMANN M. BIGGS, New York 

Mrs. ELMER BLAIR, New York 

Dr. HENRY DWIGHT CHAPIN, New York 
JOHN COLLIER, New York 

Mrs. JOHN COLLIER, New York 

Dr. JOHN DEWEY, New York 

Dr. CHARLES W. ELIOT, Cambridge 

Dr. WILLIAM R. P. EMERSON. Boston 
JOHN FARWELL, Chicago 

Dr. JOHN H. FINLEY, Albany 

Dr. SIMON FLEXNER, New York 

Mrs. BRYANT B. GLENNY, Buffalo 

Dr. ROYAL S. HAYNES, New York 

Dr. VICTOR G. HEISER, New York 

Dr. SAMUEL McCUNE LINDSAY, New York 
Jupce ROBERT S. LOVETT, Washington 
Dr. SAMUEL McC. HAMILL, Philadelphia 
HENRY McDONALD, New York 

Mrs. P. V, PENNYBACKER, Austin, Texas. 


Dr. FREDERICK PETERSON, New York 
Mrs. FREDERICK PETERSON, New York 
Dr. GODFREY R. PISEK, New York 

Mrs. WILLIAM A. READ, New York 

Dr. MARY SCHWARTZ ROSE, New York 
Rev. JOHN A. RYAN, Washington 

Dr. BERNARD SACHS, New York 

Dr. EDWARD F. SANDERSON, New York 
MORTIMER L. SCHIFF, New York 

Dr. ALBERT SHIELS, Los Angeles 

Dr. CHARLES HENDEE SMITH, New York 
Mrs. VICTOR SORCHAN, New York 
JOHN SPARGO, New York 

Mrs. WILLARD D. STRAIGHT, New York 
Mrs. LINA ROGERS. STRUTHERS, New York 
Dr. M. CAREY THOMAS, Bryn Mawr 
Mrs. FRANK A. VANDERLIP, New York 
Dr. WILLIAM H. WELCH, Baltimore 

Dr. RAY L. WILBUR, San Francisco 
WILLIAM WIRT, Gary, Ind. 

Mrs. IRA COUCH WOOD, Chicago 

Dr. THOMAS D. WOOD, New York 


289 FOURTH AVENUE 
NEW YORK 


A ten cent tape line tacked against the wall, a book 
and a pair of scales are the only necessary equipment 


STANDARDS OF NUTRITION AND GROWTH. 


| ae chief standards by which nutrition and growth are estimated 
are three: 

1. The relation of weight to height. 

2. The annual gain in weight and height. 

3. The general appearance of the child. 

Children should be weighed and measured without shoes and in 
only the usual indoor clothes; boys should remove their coats. 

All school children should be weighed at least every three months, 
at the beginning and end of the school year and twice between; Sep- 
tember, December, March and June are the best months. Those 
who are much below the normal should be weighed at least once every 
month; better, every week. 

The height should be taken twice a year, at six months’ interval; 
September and March are the best months. 

The record of the child’s weight and height should be kept through- 
out his school life. It should be made a part of his school record and 
should accompany him from one grade to another or when he is trans- 
ferred from one school to another. 

The weight for the age and the height for the age show such wide 
variations in different races, communities and families that neither 
of these can be taken as a guide to the state of the child’s nutrition. 

The relation of weight to height is the only one which is of value in 
determining this condition. This relation is but little affected by 
race or country, it being nearly the same in the average American 
and the short Japanese boy. 

The averages for American school children are given in the follow- 
ing tables, prepared by Dr. Thomas D. Wood: 


COPYRIGHT, 1918, CHILD HEALTH ORGANIZATION 


HEIGHT AND WEIGHT TABLE FOR BOYS 


The standard or normal weight for a boy is found where the hori- 
zontal column opposite his height crosses the vertical column under 
his age*. Ilustration—The standard weight for a boy 57 inches high 
and 13 years old is 83 pounds. 


Height] 5 6 Tf 8 9 10 ial 12 13 14 15 16 17 18 
Inches} Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. 


39 | 35 

40 | 37 | 38 

41 | 39} 40 

42 | 41 | 42 

43 | 43 | 44) 44 

44 | 45 | 45 | 46 

45 |....| 47 | 47 | 48 

46 |....| 49| 50] 50 

A7 51 | 52| 52 

48 53 | 54] 55 

49 55 | 56] 57 

50 58 | 59 | 59 

51 60 | 61) 62) 62 

52 64 | 65] 65 

53 |o2--\:--.| O74 68)) 6851768 
AU ee eh Perea te tan a ee TO TI aa ee 


56 17 | 79) 79) 80 
57 81 | 82| 83) 84 
58 84 | 85 | 87] 88 
59 88 | 89 | 91} 92 
60 90 | 92} 94) 95 
61 os eefe ee dt OF Sou m@O rai 
62 ...1....{100 102 |104 105 
63 .|....|104 |106 108 |109 |110 
64 woof... [E12 11S TIS V7 1120 
65 vee. o LIS ALO ee 2S 
66 .. (193 |124 1125 1127 
67 ... {125 1126 127 1131 
68 .. {130 |131 |133 |136 
69 .|....[134 1136 ]139 
70 . .{136 {140 |143 
71 |142 |145 
Te 

| 


* Note—The age is taken at the nearest birthday. 


HEIGHT AND WEIGHT TABLE FOR GIRLS 


The standard or normal weight for a girl is found where the hori- 
zontal column opposite her height crosses the vertical column under 
her age. Illustration—The standard weight for a girl 50 inches high 
and 9 years old is 59 pounds. 


Height| 5 9 IA Peo Cag eat 


6 a 8 10 16 il 18 
Inches} Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. | Yrs. 


Yrs. | Yrs. | Yrs. 


39 | 34 | 


40 | 35 | 37 
41 | 39} 39 


ems s <2. «. 21>: .>'.+.2| 68 | 68:1 69 

esas ales felt el M21 WS PA 

SD |hclei cl AGS Fae eae ee iy ee CON TE eee) 

Me ef Bee ls wee es Oe ea FO) 82 85 

Meme els. (5 esl alee Sis. cl SS 88.) 93.1 96 

BET cients Sele ee eet 9295) TOONS 

ON eee eh eae eels CnlO% | O94 103: 1077 409 

Ty. gee eae Noe aciic eel aodla caalla sacle sea) Ge) NO O er Oe UL 

| ele ace. ee. ee OAS 05 LOTMA ISTE 

eM eS Sel vealccte le tiie Te leo OF (L100 1S, (Doan 

24: |e cle dlfecc Safe eect (lata Regen eee beet borer] meme Pema Bets ral Sa fC 
aia ee fe Soa Leds sae 


Only scales with bar and weights should be purchased for school 
use. Spring scales with dial face are not very durable and are likely 
to get out of order soon. 

Measurements for height should be taken with the child standing 
with feet close together and close against the measuring rod, or for 
school use a measuring tape may be tacked against a wall and a book 
placed on the child’s head, edgewise, to mark his height. 


A special measuring rod is made by Hammacher, Schlemmer & Co., 133 Fourth Ave., New York 


ANNUAL GAIN IN WEIGHT AND HEIGHT 


While the relation of weight to height is significant as a starting 
point to determine a child’s condition as regards nutrition, his rate 
of gain in weight and height is even more important as showing his 
progress. In healthy children growth in height and gain in weight 
go on together and usually at the same rate. In neither of these is 
the increase uniform or continuous for long periods of time. There 
are seen with nearly all children periods of a few months in which 
growth and gain in weight are more rapid, followed by months in 
which both are slower. Gain in weight is usually more rapid in the 
fall and spring months; less rapid in winter and mid-summer. Chil- 
dren who are much below normal weight usually gain rapidly when 
the cause of the low weight can be removed. 


Average Annual Gain in Weight and Height 


Boys Girls 
Age Weight Height Age Weight Height 
5— 6} 4 Ibs. Oe een 5— 6| 3% lbs fase Thine 
G— Fi 4 €¢ o) 66 — a A Ce 2 Ce 
(= 8 4Vs (54 9) (a4 (= 8 4Vs e¢ Q ceé 
Que. 9 5 ee o) ce oe 9 5 c¢ 134 ce 
C10) Ue Oa Me! Gle aly “ 
Vest ee 134 “ 10—11 | 647 eee 
hel aa (OA = 11-=12 | OU45 ime eat ae 
LAs 8 s Dr oat 21s 10%“ Did cis" 
134 |) 10 3 gM, 13—14 9144 “* Dee an 
ie onl Re a 14—15 eo yy“ 
15—16 | 14 se Ql, “ W515 6 a oi 
gia oleae: Ale: 1617) Sa Ve 
ee oe eee te Byntt 17-18) | ae ane 
Approximate Monthly Gain in Weight 
Boys | Girls 
Age Gain Age Gain 
DLO os years 6 ounces 5 to 8 years 6 ounces 
14 50 uy | As Bly oe Bitoni ses Brie 
IS te 16> Ges ss Eto tA TQ) es 
16to18 “ Sig ae 14 to 16s S250 
16 toler te At Tia 


Weight variations —Variations in the annual rate of gain of a 
pound or a pound and a half on either side of the average, are common 
in healthy boys between the ages of five and twelve years; and varia- 
tions of three or four pounds on either side of the average are common 
from the thirteenth to the sixteenth year. Girls gain at the same rate 
as boys up to the age of ten years, during the next year they gain 
more rapidly and pass the boys, remaining ahead until about fifteen 
years old when the boys overtake and pass them permanently. 


Height variations. —Variations in the annual gain of healthy boys 
up to the fourteenth year are seldom more than half an inch above 
or below the average, and from the fourteenth to the seventeenth year 
seldom more than one inch over or below the average. Variations 
in girls are seldom more than half an inch above or below the average 
at any age, being greatest in the thirteenth and fourteenth years. 
Height is much less affected by undernourishment than is weight. 
Too rapid growth may in itself even be a cause of undernourishment. 

A child whose annual gain in weight is much below the average 
given in the tables is not in a normal condition as regards his nutri- 
tion and the cause of this should be carefully investigated. A child 
may be considered undernourished whose weight for his height is 
10 per cent or more below the average given in the tables. 

There are some exceptions to this general rule. Certain children 
(this group is not a large one) may be stunted in growth by conditions 
which also affect weight, so that the relation of weight to height is 
normal, although the child is much below the standard in both. 


The general appearance of the child is much less significant than 
his weight and height in determining his nutrition; but when taken in 
connection with weight and height and when the observations are 
made by an experienced person, the general appearance gives valuable 
information. The child’s face tells much; whether his expression 
shows keen interest, with bright eyes, red lips and plump and rosy 
cheeks; or whether his expression is dull and listless, with thin, pale 
cheeks and dark rings about the eyes. All the latter indicate under- 
nourishment, fatigue, exhaustion or actual illness. If the clothing 
is removed to the waist, not only can round shoulders and narrow 
chests be readily discovered but also the general nutrition of the body 
estimated by simple inspection. 

It is customary to record the nutrition as, I., excellent; II., farr; 
III., distinctly below par; IV., very bad. Children may very well be 
graded in this way, their rating changing from time to time with their 
- progress. 

Observations made upon the child’s general appearance as an 
indication of his nutrition are more valuable when made by a school 
doctor or a school nurse, but much information can be obtained from 
the observations of the teacher alone. 


The Story 
of the CHILD HEALTH ORGANIZATION 


told in Four Paragraphs 


I PURPOSE 


Health standards of American children are being lowered. Mulnutrition, tuber- 
culosis and lessened resistance to disease generally are a price of the world war. 
Disastrous results of our past neglect in matters of health education were revealed 
in the examinations of the selective draft. Our future guardians of democracy must 
be safeguarded in health. To do this is the purpose of the Child Health Organization. 


II PLAN 


TO TEACH health habits to children, and to secure adequate health examinations 
and health records for all children in the public schools of the country. 


TO CONSIDER the urgent problem of malnutrition among school children. 
TO SAFEGUARD the health of children in industry. 


TO COOPERATE with other bodies in securing an enlightened public opinion and 
legislation in these matters. 


Il LITERATURE 


The following material has been prepared. Other publications are under way. 


1. Weight Card—Showing proper rela- 
tion between weight and height for boys 
and girls from five to eighteen. $1.00 
per 100. 

2. Class Room Record—A method of in- 
teresting groups of children in weight. 
$3.00 per 100. 

3. Teachers’ Service Booklet—Facts 
about malnutrition, and ways of com- 
bating it in the classroom. Free. 

4. Demonstration Pamphlet—A_ report 
about twenty-five Food Scouts who grew 


strong while eating Mr. Hoover’s kind 
of lunches. Free. 


5. Tag — Used in weighing contests, to 
carry facts into the children’s homes. 
$1.00 per 100. 


6. Standards of Nutrition and Growth. 
5 cents a copy. 

7. How to Conduct a Nutrition Class. 10 
cents per copy. 

8. The Diet of School Children. 
per copy. 


10 cents 


IV SERVICE 


The Child Health Organization will be glad, if expenses are paid, to furnish a 
speaker, look over the field in your community and make suggestions for local work, 
furnish literature at cost, and to help you in every way along the lines here indicated. 
A communication from you expressing your views and position will be welcome. 


CHILD HEALTH ORGANIZATION 
289 FOURTH AVENUE, NEW YORK 


COLUMBIA UNIVERSITY LIBRARIES 


This book is due on the date indicated below, or at the 
expiration of a definite period after the date of borrowing, as 
provided by the library rules or by special arrangement with 
the Librarian in charge. 


DATE BORROWED DATE DUE 


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m 
0 
oO 
2 
F 
Ce) 
= 
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hp 


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1916 _ 


Child health organization of Amer- 
lea. ; Sarit alee 
Standards of nutrition and growth 


